Discontinuity of Chronic Medications in Patients Discharged from the Intensive Care Unit

Authors

  • Chaim M. Bell MD, PhD, FRCP(C),

    1. Faculty of Medicine, University of Toronto, Toronto, ON, Canada
    2. Department of Medicine, University of Toronto, Toronto, ON, Canada
    3. Department of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
    4. The Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada
    5. Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
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  • Parisa Rahimi-Darabad MD,

    1. Faculty of Medicine, University of Toronto, Toronto, ON, Canada
    2. Department of Medicine, University of Toronto, Toronto, ON, Canada
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  • Avi I. Orner MD

    1. Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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  • None of the authors have any conflicts of interest to declare.

  • Preliminary findings were presented in abstract form at the 29th Annual Meeting of the Society of General Internal Medicine in New Orleans in May 2005.

Address correspondence and requests for reprints to Dr. Bell: St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada M5B 1W8 (e-mail: bellc@smh.toronto.on.ca).

Abstract

BACKGROUND: Intensive care unit (ICU) admission may connote an elevated risk of unintentional chronic medication discontinuation because of its focus on acute illnesses and the multiple care transitions.

OBJECTIVE: To determine the proportion of patients discharged from the ICU whose previously prescribed chronic medications were unintentionally discontinued during their hospitalization.

DESIGN AND PARTICIPANTS: Hospital records of consecutive ICU discharges at 1 academic and 2 community hospitals in Toronto, Canada, throughout 2002 were reviewed. Eligible patients were prescribed at least 1 of 6 medication groups before hospitalization: (1) HMG co-A reductase inhibitors (statins); (2) antiplatelets/anticoagulants (aspirin, clopidogrel, ticlopidine, warfarin); (3) l-thyroxine; (4) non-prn inhalers (anticholinergic, β-agonist, or steroid); (5) acid-suppressing drugs (H2 antagonists and proton pump inhibitors); and (6) allopurinol.

MEASUREMENTS: Use of explicit criteria to assess the proportion of patients whose previously prescribed chronic medications were unintentionally discontinued at hospital discharge.

RESULTS: A total of 1,402 charts were eligible for the study and 834 had prescriptions for at least 1 of the medication groups. Thirty-three percent (251/834) of patients had 1 or more of their chronic medications omitted at hospital discharge. Multivariable logistic regression analysis found that patients from the academic hospital (adjusted odds ratio [OR]=0.70, 95% confidence interval [CI] 0.49 to 1.0) and those with medical diagnoses (adjusted OR=0.48, 95% CI 0.31 to 0.75) had a decreased risk for chronic medication discontinuation.

CONCLUSIONS: Patients discharged from the ICU often leave the hospital without note of their previously prescribed chronic medications. Careful review of medication lists at ICU discharge could avoid potential adverse outcomes related to unintentional discontinuation of chronic medications at hospital discharge.

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